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Does a Person's Insurance Coverage Affect Their Access to Quality Cancer Care?

Research shows disparities in quality of care for kidney cancer patients with Medicare

CHICAGO (April 26, 2009) – Does a person's insurance coverage affect their access to quality cancer care? According to researchers at Fox Chase Cancer Center, insurance coverage may not only affect a patient's access to health care, but also the quality of care they receive. Research findings, presented today at the American Urological Association's Annual Meeting, may have implications for a national debate on healthcare reform.

"We discovered a discrepancy in the type of surgical treatment patients are offered based on their health insurance," says Robert G. Uzzo, MD, chairman of the department of surgery at Fox Chase and the study's lead author. His research evaluated differences in surgical treatment for kidney cancer based on a patient's health insurance carrier. The study explored this question in one specific area of medicine, but the results may have implications for other areas of medicine as well.

The study results showed that kidney cancer patients with Medicare as their primary payer were more likely to have their kidney surgically removed entirely (radical nephrectomy) whereas those with private insurance were offered surgery to preserve organ function (partial nephrectomy).

"The notion that the kind of insurance you have can affect the quality of the care you receive has implications for the ongoing discussion about national healthcare reform. This research raises important questions for the government to consider," adds Uzzo. "As our national leaders begin to discuss healthcare reform, it will be important to keep in mind that who pays for the care can affect the quality of care received."

Kidney cancer is commonly treated by surgically removing the entire organ, but this is often unnecessary. Due to its technical demands, however, kidney-sparing surgery remains widely underutilized except at high-volume academic centers, where surgeons are experienced not only in resection of very complex kidney tumors but also in minimally-invasive techniques to treat patients with kidney cancer.

There are numerous long-term health benefits to patients when the non-cancerous portion of the kidney can be preserved. These include preserving maximum kidney function, reducing the risk of dialysis down the road and a longer life expectancy.

Uzzo's study evaluated the potential impact of a patient's primary insurance status as it relates to the likelihood of the patient undergoing a radical or partial nephrectomy. The study relied oninpatient discharge data from nearly 42,000 adult patients in New York, New Jersey and Pennsylvania over a six-year period.

The study results revealed that disparities in quality of care exist. Patients 65 and over, with Medicare coverage, were significantly less likely to undergo kidney-sparing surgery for treatment of renal malignancy (kidney cancer) than patients whose primary payer was a private insurance carrier.

Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, call 1-888-FOX CHASE or (1-888-369-2427).

Disclaimer: Temple University Health System (TUHS) neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents. Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System and by Temple University School of Medicine.